Using an array of implementation strategies to improve success rates of pharmacist-initiated medication therapy management services in community pharmacies

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Background:With the introduction of the Centers for Medicare and Medicaid Services Stars Measure program has come a greater expectation of Medication Therapy Management (MTM) services from community pharmacies. To meet the growing demand of these services, pharmacies have sought out various methods of engaging pharmacists to provide MTM. Barriers for completing MTM include inadequate time to complete the services, insufficient staffing, lack of sufficient compensation, billing difficulty, lack of interest among patients (including refusing MTM services when offered), inadequate training/experience, and lack of support from management.Objective:To evaluate the impact of a financial incentive alone versus the incentive plus a package of individualized implementation strategies on the success rate of MTM services.Methods:To increase MTM completion rates, The Kroger Company implemented a financial incentive for pharmacists in one of its market services areas. The following year the incentive was continued and an array of training and support strategies were implemented. The numbers of MTM claims and success rates for 2013 (no intervention), 2014 (financial incentive alone), and 2015 (incentive plus required training and ongoing support) were compared.Results:A total of 7038 claims were extracted from 2013 to 2015. The number of completed claims had increased from 1385 in 2013 to 3265 in 2015. The total MTM success rates rose significantly from 42.9% in 2013 to 49.0% in 2014 (p = 0.001) and to 64.0% in 2015 (p < 0.001).Conclusions:A financial incentive plus a package of individualized implementation strategies increases success rates of MTM services compared to a financial incentive alone.HIGHLIGHTSFinancial incentives provided a modest improvement to pharmacist performance.Clinical team support provided higher completion rates than incentives alone.Overall success rates were driven by in-store pharmacists' participation.Success rates of in-store pharmacists were higher than clinical pharmacists.

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